The procoagulant activity of red blood cells from patients with severe preeclampsia

OBJECTIVE: Our purpose was to determine whether red blood cells from patients with severe preeclampsia may exhibit increased membrane exposure of procoagulant phospholipids (i.e., phosphatidylserine), which may initiate intravascular clotting and platelet activation. STUDY DESIGN: The study group comprised 28 women: 9 with severe preeclampsia in the third trimester of pregnancy, 10 normotensive with uncomplicated pregnancies, and 9 age-matched, nonpregnant, healthy women. The exposure of phosphatidylserine on the outer membrane phospholipid layer was analyzed with use of isolated, washed red blood cells that were added as a source of phospholipids to a "prothrombinase" coagulation complex. RESULTS: The resultant thrombin formed was measured by an amidolytic assay. Thrombin generation significantly increased on the addition of red blood cells from women with preeclampsia (741 +/- 132 mU/ml/min) compared with red blood cells from normotensive pregnant (422 +/- 228 mU/ml/min) and nonpregnant women (316 +/- 268 mU/ml/min, p = 0.0008). CONCLUSION: This study indicates that in patients with preeclampsia the red blood cells exhibit a significant procoagulant surface that may trigger thrombin formation, thereby playing a role in the hypercoagulable state.     

Developmental intrahepatic shunts of childhood: radiological features and management

The purpose of this study was to evaluate the role of radiological techniques in the diagnosis and management of developmental intrahepatic shunts. Hepatic vascular fistulae are recognised sequelae of liver trauma and intrahepatic tumours. However, there are rare developmental malformations which may present in childhood or later life and which may carry life-threatening complications. Retrospective analysis of clinical and radiological data was carried out in 24 patients. Anomalies evaluated were: (a) direct communication between hepatic artery and hepatic veins; (b) congenital hepatoportal arteriovenous malformations; and (c) congenital portocaval anastomosis with persistent flow through the ductus venosus. Although rare, the prompt recognition of these vascular anomalies allows early surgical or radiological intervention and reversal of the haemodynamic complications.     

Symptom reduction and sobriety in the male alcoholic

The relationship between subjective symptom reduction and sobriety was studied for 82 male alcoholics who had completed an inpatient Alcoholic Rehabilitation Unit that included six or more biofeedback/relaxation sessions. Specific symptom relief for anxiety was significantly correlated with sobriety. In addition, the reduction of symptoms showed a positive trend with sobriety. The discussion focuses on the relationship of anxiety-related symptoms and alcohol abuse.     

Effects of lorazepam on the distribution of spatial attention

A left persistent primitive sciatic artery was observed in a Japanese male cadaver. The sciatic artery arose from the internal iliac artery and perforated the ventral division of the sacral plexus. The sciatic artery did not anastomose with the perforating arteries nor the popliteal artery. The left femoral artery was incompletely developed, attenuating and terminating as the saphenous artery. Instead of the femoral artery, direct continuation of the profunda femoris artery, which probably corresponded to the fourth perforating artery, became the popliteal artery. Other vessel anomalies were observed in various regions. They included; (1) the retroesophageal right subclavian artery; (2) the left vertebral artery entering the transverse foramen of the 4th cervical vertebra; (3) bilateral occurrence of the superficial brachial artery; (4) the left gastric artery independently arising from the abdominal aorta; (5) a hepatolienomesenteric trunk; (6) three accessory renal arteries; (7) double testicular arteries; (8) the arteria intermesenterica; (9) a venous ring termed the 'renal collar', and (10) paired thoracic ducts. The present cadaver was considered to be a very rare case in which many primitive vascular systems had extensively persisted in various parts of the body.     

Isolation and identification of a plasmatocyte-spreading peptide from the hemolymph of the lepidopteran insect Pseudoplusia includens

Insect blood cells (hemocytes) play an essential role in defense against parasites and other pathogenic organisms that infect insects. A key class of hemocytes involved in insect cellular immunity is plasmatocytes. Here we describe the isolation and identification of a peptide from the moth Pseudoplusia includens that mediates the spreading of plasmatocytes to foreign surfaces. This peptide, designated plasmatocyte-spreading peptide (PSP1), contains 23 amino acid residues in the following sequence: H-ENFNGGCLAGYMRTADGRCKPTF-OH. In vitro assays using the synthetic peptide at concentrations >/=2 nM induced plasmatocytes from P. includens to spread on the surface of culture dishes. Injection of this peptide into P. includens larvae caused a transient depletion of plasmatocytes from circulation. Labeling studies indicated that this peptide induced 75% of plasmatocytes that were double-labeled by the monoclonal antibodies 49G3A3 and 43E9A8 to spread, whereas plasma induced significantly more plasmatocytes to spread. This suggests that only a certain subpopulation of plasmatocytes responds to the peptide and that other peptidyl factors mediate plasmatocyte adhesion responses.     

Effects of the allosteric modification of hemoglobin on brain oxygen and infarct size in a feline model of stroke

BACKGROUND AND PURPOSE: Cerebral ischemia and stroke are leading causes of morbidity and mortality. An approach to protecting the brain during ischemia is to try to increase the delivery of oxygen via the residual blood flow through and around ischemic tissue. To test this hypothesis, we used a novel oxygen delivery agent, RSR-13 (2-[4-[[(3,5-dimethylanilino)-carbonyl]-methyl]phenoxy]-2-methylpr opionic acid). Intravenous administration of RSR-13 increases oxygen delivery through allosteric modification of the hemoglobin molecule, resulting in a shift in the hemoglobin/oxygen dissociation curve in favour of oxygen delivery. METHODS: We studied RSR-13 in a feline model of permanent middle cerebral artery occlusion to assess its effects on cerebral oxygenation and infarct size. A randomized, blinded study of RSR-13 (n = 6) versus 0.45% saline (n = 12) was conducted, after an RSR-13 dose-escalation study (n = 4). Drug was administered as a preocclusion bolus followed by a continuous infusion for the duration of the experiment (5 hours). Brain oxygen was measured continuously with the use of a Clark oxygen electrode. Infarct size was measured at 5 hours after occlusion with computer-assisted volumetric analysis. RESULTS: The drug treatment group had consistently higher mean brain oxygen tension than controls (33 +/- 5 and 27 +/- 6 mm Hg, respectively) and significantly smaller infarcts (21 +/- 9% versus 33 +/- 9%, respectively, P < .008). We observed an inverse relationship between the dose response of RSR-13 (the shift in the hemoglobin/oxygen dissociation curve) and infarct size. CONCLUSIONS: These results are evidence that allosteric hemoglobin modification is protective to the brain after acute focal ischemia, providing a new opportunity for neuroprotection and raising the possibility of enhancing the protective effect of thrombolysis and ion channel blockade.     

Differential rates of age of seizure onset between sexes and between hemispheres?

The American Diabetes Association and a working group of the International Diabetes Federation and the World Health Organisation are considering the possibility of lowering the level of fasting glucose for diagnosis of diabetes from 7.8 mM to 7.0 mM (126 mg/dl) and adding a "hyperglycaemia" category (6.1-6.9 mM). This report studied the resulting change in the frequency of diabetes in the French D.E.S.I.R. cohort and evaluated cardiovascular risk factors according to the proposed limits. The frequency of treated diabetes was 1.0% in this cohort of more than 5,000 French men and women 30 to 64 years of age, 0.7% had a fasting glucose > or = 7.8 mM versus 1.6% for the proposed > or = 7.0 mM. Using the new criteria, 3.8% of men and 1.6% of women would be diabetic. For many cardiovascular risk factors, men with fasting glucose > or = 7.8 mM had a significantly higher risk than those in the (7.0-7.7 mM) range, whereas no significant differences were found for women. There were few differences between the (7.0-7.7 mM) and (6.1-6.9 mM) ranges, but highly significant differences were apparent for both sexes between the normoglycaemic (< 6.1 mM) and hyperglycaemic (6.1-6.9 mM) categories. The percentage of men with two or more of ten risk factors increased with fasting glucose: 36% in the normoglycaemic (< 6.1 mM) and 49% in the hyperglycaemic (6.1-6.9 mM) categories; 73% with fasting glucose in (7.0-7.7 mM) versus 90% with fasting glucose > or = 7.8 mM. In women, the corresponding percentages were lower: 26% and 60%, 32% versus 64% respectively. The major increase in cardiovascular risk factors would appear to occur at 6.1 mM, for men, whereas the increase in the combination of risk factors was at the more conservative cut-off of 7.0 mM.